MR imaging characterization of postischemic myocardial dysfunction ("stunned myocardium"): relationship between functional and perfusion abnormalities.

Stunned myocardium has been detected in patients treated successfully with thrombolytic agents. The hypothesis of this study was that fast gradient echo (GRE) imaging could be used to characterize the regional functional and perfusion abnormalities that are indicative of myocardial stunning. This study was designed to monitor and correlate the extent of wall thickness and perfusion abnormalities as determined by fast (segmented k space) cine and contrast enhanced GRE imaging, respectively. Dogs were subjected to left circumflex (LCX) coronary artery occlusion (15 min) followed by 30-minute reperfusion (n = 8). Perivascular flow probes were used to continuously measure flow in left anterior descending (LAD) and LCX coronary arteries. Short-axis inversion recovery prepared fast GRE and cine images were acquired at baseline, at occlusion, and at 1, 10, and 30 minutes of reflow. Regional signal intensity and percent systolic wall thickening were determined at 26 equally spaced circumferential positions to compare the extent of functional and perfusion abnormalities. During occlusion and reperfusion, the ischemic region was demonstrated on contrast-enhanced images as a hypointense and hyperintense region, respectively. During occlusion, the extent of the perfusion defect (32% +/- 2% of the circumference of the equatorial slice) correlated closely (r = .74) with the extent of contractile dysfunction (35% +/- 2%). After reperfusion, there was transient recovery in the percent wall thickening (26% +/- 4% vs 36% +/- 4% normal), coinciding with the reactive hyperemic response, but this was followed by a significant decline in wall thickening at 10 minutes (19% +/- 4%) and 30 minutes (12% +/- 2%). Fast MR imaging may be useful to monitor postischemic myocardial abnormalities after thrombolytic therapy and the response to pharmacologic interventions.